Symptoms of vascular dementia or dementia. The appearance and treatment of cerebral vascular dementia Complications of vascular dementia

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As a person ages, failures begin to occur in all systems and organs. There are also deviations in mental activity, which are divided into behavioral, emotional and cognitive. The latter includes dementia (or dementia), although it has a close relationship with other disorders. Simply put, in a patient with dementia, due to mental disorders, behavior changes, causeless depression appears, emotionality decreases, and the person begins to gradually degrade.

Dementia usually develops in older people. It affects several psychological processes: speech, memory, thinking, attention. Already on initial stage Vascular dementia, the resulting disorders are quite significant, which affects the patient’s quality of life. He forgets already acquired skills, and learning new skills becomes impossible. Such patients have to leave their professional career, and they simply cannot do without the constant supervision of family members.

General characteristics of the disease

Acquired cognitive impairments that negatively affect a patient's daily activities and behavior are called dementia.

The disease can have several degrees of severity depending on the social adaptation of the patient:

1. Mild degree of dementia - the patient experiences a degradation of professional skills, his social activity decreases, and interest in favorite activities and entertainment weakens significantly. At the same time, the patient does not lose orientation in the surrounding space and can take care of himself independently.
2. Moderate (average) degree of dementia - characterized by the impossibility of leaving the patient unattended, since he loses the ability to use most household appliances. Sometimes it is difficult for a person to open the lock on his own. front door. This degree of severity is often referred to colloquially as “ senility" The patient requires constant help in everyday life, but he can cope with self-care and personal hygiene without outside help.
3. Severe degree - the patient has complete disadaptation to the environment and personality degradation. He can no longer cope without the help of his loved ones: he needs to be fed, washed, dressed, etc.

There can be two forms of dementia: total and lacunar(dysmnestic or partial). The latter is characterized by serious deviations in the process of short-term memory, while emotional changes are not particularly pronounced (excessive sensitivity and tearfulness). Typical option lacunar dementia can be considered in the initial stage.

The form of total dementia is characterized by absolute personal degradation. The patient is exposed to intellectual and cognitive disorders, the emotional-volitional sphere of life changes radically (there is no sense of shame, duty, vital interests and spiritual values ​​disappear).

WITH medical point In terms of vision, there is the following classification of types of dementia:

• Dementia of the atrophic type (Alzheimer's disease, Pick's disease) usually occurs against the background of primary degenerative reactions occurring in the cells of the central nervous system.
• Vascular dementia (atherosclerosis, hypertension) - develops due to circulatory pathologies in the cerebral vascular system.
• Dementia of mixed type - the mechanism of their development is similar to both atrophic and vascular dementia.

Dementia often develops due to pathologies leading to the death or degeneration of brain cells (as an independent disease), and can also manifest itself as severe complication diseases. In addition, conditions such as skull trauma, brain tumors, alcoholism, etc. can be causes of dementia.

For all dementias, such signs as emotional-volitional (tearfulness, apathy, causeless aggression, etc.) and intellectual (thinking, speech, attention) disorders, up to personal disintegration, are relevant.

Vascular dementia

This type of disease is associated with impaired cognitive function due to abnormal blood flow in the brain. Vascular dementia is characterized by a long development pathological processes. The patient practically does not notice that he is developing brain dementia. Due to disturbances in blood flow, certain brain centers begin to experience pain, which causes the death of brain cells. A large number of such cells leads to brain dysfunction, which manifests itself as dementia.

Causes

Stroke is one of the root causes of vascular dementia. Both, and, which distinguish a stroke, deprive brain cells of proper nutrition, which leads to their death. Therefore, stroke patients are at particularly high risk of developing dementia.

It can also cause dementia. Due to low blood pressure, the volume of blood circulating through the vessels of the brain decreases (hyperfusion), which subsequently leads to dementia.

In addition, dementia can be caused by ischemia, arrhythmia, diabetes, infectious and autoimmune vasculitis, etc.

As mentioned above, often the cause of such dementia can be. As a result, the so-called atherosclerotic dementia gradually develops, which is characterized by a partial stage of dementia - when the patient is able to realize that he is experiencing impairments in cognitive activity. This dementia is different from other dementias, it progresses in steps clinical picture, when episodic improvements and deteriorations of the patient’s condition periodically replace each other. Atherosclerotic dementia is also characterized by dizziness, speech and visual abnormalities, and slow psychomotor skills.

Signs

Typically, a doctor diagnoses vascular dementia in cases where disruptions in cognitive functions begin to appear after an experience or a stroke. A harbinger of the development of dementia is also considered to be weakening of attention. Patients complain that they cannot concentrate on a certain object or concentrate. Characteristic symptoms Dementia is considered to be changes in gait (mincing, wobbly, “skiing”, unsteady gait), voice timbre and articulation. Swallowing dysfunction is less common.

Intellectual processes begin to work in slow motion - also an alarming signal. Even at the beginning of the disease, the patient experiences some difficulties in organizing his activities and analyzing the information received. In the process of diagnosing dementia in the initial stages, the patient is given a special test for dementia. With its help, they check how quickly the subject copes with specific tasks.

By the way, with vascular type of dementia memory deviations are not particularly pronounced, which cannot be said about emotional sphere activities. According to statistics, about a third of patients with vascular dementia are depressed. All patients are subject to frequent mood swings. They can laugh until they cry, and suddenly suddenly begin to cry bitterly. Patients often suffer from hallucinations, epileptic seizures, show apathy towards the world around them, and prefer sleep to wakefulness. In addition to the above, symptoms of vascular dementia include impoverishment of gestures and facial movements, i.e., motor activity is impaired. Patients experience urinary disturbances. A characteristic feature of a patient suffering from dementia is also sloppiness.

Treatment

There is no standard, template method for treating dementia. Each case is considered by a specialist separately. This is due to a huge number of pathogenetic mechanisms preceding the disease. It should be noted that dementia is completely incurable, so the disorders caused by the disease are irreversible.

Treatment of vascular dementia, and other types of dementia too, is carried out with the help of drugs that have a positive effect on brain tissue, improving their metabolism. Also, dementia therapy involves treating directly the diseases that led to its development.

Cerebrolysin and nootropic drugs are used to improve cognitive processes. If the patient is subject to severe forms of depression, then, along with the main treatment of dementia, he is prescribed antidepressants. To prevent cerebral infarctions, antiplatelet agents and anticoagulants are prescribed.

Do not forget about: giving up smoking and alcohol, fatty and too salty foods, you should move more. Life expectancy with advanced vascular dementia is about 5 years.

It should be noted that Demented people often develop such an unpleasant trait as sloppiness Therefore, relatives need to provide proper care for the patient. If household members cannot cope with this, then you can resort to the services of a professional nurse. This, as well as other common questions related to the disease, should be discussed with those who have already encountered similar problems on a forum dedicated to vascular dementia.

Video: vascular dementia in the program “Live Healthy!”

Senile (senile) dementia

Many, observing elderly household members, often notice changes in their condition associated with character, intolerance and forgetfulness. From somewhere an irresistible stubbornness appears, and it becomes impossible to convince such people of anything. This is due to brain atrophy due to the large-scale death of its cells due to age, i.e., senile dementia begins to develop.

Signs

First, an elderly person begins minor memory impairments– the patient forgets recent events, but remembers what happened in his youth. As the disease progresses, old fragments begin to disappear from memory. In senile dementia, there are two possible mechanisms for the development of the disease, depending on the presence of certain symptoms.

Most elderly people with senile dementia have virtually no psychotic states, which makes life much easier for both the patient and his relatives, since the patient does not cause much trouble.

But there are also frequent cases of psychosis, accompanied by either sleep inversion. This category of patients is characterized by such signs of senile dementia as hallucinations, excessive suspicion, mood swings from tearful tenderness to righteous anger, i.e. A global form of the disease is developing. Fluctuations can trigger psychosis blood pressure(hypotension, hypertension), changes in blood levels (diabetes), etc. Therefore, it is important to protect elderly people with dementia from all sorts of chronic and viral diseases.

Treatment

Healthcare professionals do not recommend treating dementia at home, regardless of the severity and type of disease. Today there are many boarding houses and sanatoriums, the main focus of which is the maintenance of just such patients, where, in addition to proper care, treatment of the disease will be carried out. The issue is certainly controversial, since in the comfort of home it is much easier for the patient to endure dementia.

Treatment of senile type dementia begins with traditional psychostimulant drugs based on both synthetic and herbal components. In general, their impact is manifested in increased opportunities nervous system the patient to adapt to the resulting physical and mental stress.

Nootropic drugs are used as mandatory drugs for the treatment of dementia of any type, which significantly improve cognitive abilities and have a restorative effect on memory. In addition, modern drug therapy often uses tranquilizers to relieve anxiety and fear.

Since the onset of the disease is associated with serious memory impairment, you can use some folk remedies. For example, blueberry juice has a positive effect on all processes related to memory. There are many herbs that have a calming and hypnotic effect.

Video: Cognitive training for people with dementia

Alzheimer's type dementia

This is perhaps the most common type of dementia today. It refers to organic dementia (a group of dementive syndromes that develop against the background of organic changes in the brain, such as cerebrovascular diseases, traumatic brain injuries, senile or syphilitic psychoses). In addition, this disease is quite closely intertwined with types of dementia with Lewy bodies (a syndrome in which the death of brain cells occurs due to Lewy bodies formed in neurons), having many common symptoms with them. Often even doctors confuse these pathologies.

The most significant factors provoking the development of dementia:

1. Old age (75-80 years);
2. Female;
3. Hereditary factor (presence of a blood relative suffering from Alzheimer's disease);
4. Arterial hypertension;
5. Diabetes;
6. Atherosclerosis;
7. Obesity;
8. Related diseases.

The symptoms of Alzheimer's type dementia are generally identical to those of vascular and senile dementia. These are memory impairments; first, recent events are forgotten, and then facts from life in the distant past. As the disease progresses, emotional and volitional disturbances appear: conflict, grumpiness, egocentrism, suspicion (senile personality restructuring). Untidyness is also present among the many symptoms of dementia syndrome.

Then the patient develops delusions of “damage,” when he begins to blame others for stealing something from him or wanting to kill him, etc. The patient develops a craving for gluttony and vagrancy. At the severe stage, the patient is consumed by complete apathy, he practically does not walk, does not talk, does not feel thirst or hunger.

Since this dementia refers to total dementia, the treatment is complex, covering the treatment of concomitant pathologies. This type of dementia is classified as progressive, it leads to disability and then death of the patient. As a rule, no more than a decade passes from the onset of the disease to death.

Video: how to prevent the development of Alzheimer's disease?

Epileptic dementia

Quite a rare disease occurring, as a rule, against the background of schizophrenia. For him, the typical picture is a paucity of interests; the patient cannot highlight the main essence or generalize something. Often, epileptic dementia in schizophrenia is characterized by excessive sweetness, the patient constantly expresses himself in diminutive words, vindictiveness, hypocrisy, vindictiveness and ostentatious fear of God appear.

Alcoholic dementia

This type of dementia syndrome is formed due to long-term alcohol-toxic effects on the brain (over 1.5-2 decades). In addition, factors such as liver lesions and disorders play an important role in the development mechanism. vascular system. According to research, on last stage The patient has alcoholism pathological changes in areas of the brain that are atrophic in nature, which outwardly manifests itself as personality degradation. Alcoholic dementia can regress if the patient completely abstains from alcoholic beverages.

Frontotemporal dementia

This presenile dementia, often called Pick's disease, involves the presence of degenerative abnormalities that affect the temporal and frontal lobes of the brain. In half of cases, frontotemporal dementia develops due to a genetic factor. The onset of the disease is characterized by emotional and behavioral changes: passivity and isolation from society, silence and apathy, disregard for decency and sexual promiscuity, bulimia and urinary incontinence.

Drugs such as Memantine (Akatinol) have proven effective in the treatment of such dementia. Such patients live no more than ten years, dying from immobility or the parallel development of genitourinary and pulmonary infections.

Dementia in children

We looked at types of dementia that exclusively affect the adult population. But there are pathologies that develop mainly in children (Lafora disease, Niemann-Pick disease, etc.).

Childhood dementias are conventionally divided into:

Dementia in children may be a sign of a certain mental pathology, for example, schizophrenia or mental retardation. Symptoms appear early: the child suddenly loses the ability to remember anything, and his mental abilities decrease.

Therapy for childhood dementia is based on curing the disease that triggered the onset of dementia., as well as on the general course of the pathology. In any case, the treatment of dementia is carried out with the help of the exchange of cellular substances.

With any type of dementia, loved ones, relatives and household members should treat the patient with understanding. After all, it’s not his fault that he sometimes does inappropriate things, it’s the illness that does it. We ourselves need to think about preventive measures ah, so that the disease does not strike us in the future. To do this, you should move more, communicate, read, and engage in self-education. Walking before bed and active rest, giving up bad habits - this is the key to old age without dementia.

Vascular dementia(dementia) is a disease acquired during life, which most often develops in older people after 60 years of age.

According to medical statistics, this disease more often affects men. There are cases of diagnosing pathology in young people. Progressive vascular dementia is the most common of all neurological diseases after.

This is one of the types of dementia, which is distinguished by its vascular origin, that is, damage occurs to individual areas in the area of ​​​​the blood vessels of the brain and.

At the same time, insufficiency of the most important cognitive (cognitive) functions of the brain, which provide the ability to cognition and study of the surrounding world, perceive it as a single whole, and apply this knowledge in the process of life, intensively develops.

Thinking abilities and the ability to make correct decisions are gradually lost, the assimilation of new information deteriorates, the decline in intelligence progresses, and control over emotions and actions weakens. Accordingly, it becomes impossible to analyze one’s health status and understand the presence of a disease.

Dementia of this type leads not only to the loss of work skills, but also to the gradual loss of the ability to care for oneself.

Mechanism of occurrence and development of the disease

Acute cerebrovascular accidents (,) or chronic failure blood supply to the brain are mechanisms of the pathogenesis of vascular dementia. There have been cases of the development of senile dementia in the presence of both causes. Signs of the disease appear faster and are more pronounced.

Both cerebral circulation disorders and insufficiency lead to the fact that in certain areas of the brain cells stop receiving the nutrients and oxygen necessary for life and die.

With a heart attack of a small number of neurons, there are no manifestations of the disease, since living brain cells compensate for their functions. When a large area of ​​the brain is damaged, symptoms of vascular dementia appear. But in cases of even slight damage to the area responsible for cognitive functions, dementia begins to develop and progress.

Main causative factors of the disorder

Medicine names a fairly large number of reasons due to which vascular dementia can develop:

• acute heart failure;
• chronic cerebral ischemia (blockage of small vessels);
• vasculitis ( autoimmune diseases, in which the walls of blood vessels are affected).

There are a number of factors contributing to the development of the disease:

• old age (60 years and older);
• heart disease (with atrial fibrillation, ischemic disease, heart defects);
• arterial hypertension or hypotension;
• diabetes;
• heredity;
• bad habits;
• sedentary lifestyle.

The increasing prevalence of arterial hypertension has made it a leader among all risk factors for the emergence and further development of this type of dementia.

Stages of dementia development

The course and development of vascular dementia is conventionally divided into three stages, which differ in symptoms and their severity:

1. Easy stage senile dementia is characterized by blurred manifestations of the disease. The patient, as a rule, does not notice them. Sometimes relatives and friends pay attention to changes in his life and behavior. At the same time, a slight decrease in intelligence becomes noticeable, and a dramatic change in mood and emotions can occur. But the patient controls them and controls his actions. He copes with everyday issues independently and does not need outside help.
2. Moderate Vascular dementia has more pronounced and noticeable manifestations. The patient’s life is complicated by the inability to navigate in space; a personality disorder occurs with behavioral deviations. Signs of aggression appear. Skills and abilities in handling household appliances, devices, communications equipment and the simplest objects are lost. The patient needs outside help.
3. Coping with severe Dementia is only possible with the constant help of loved ones. At this stage, a deep breakdown of the psyche is expressed. Difficulties arise with eating, control over the processes of urination and bowel movements is lost. The patient cannot perform simple hygiene procedures; he does not accept his family and friends. The patient is completely dependent on others.

However, it cannot be said that all cases of vascular dementia develop to a severe condition, although most forecasts are not encouraging - the duration and quality of life are not encouraging.

Symptoms at each stage

The first symptoms of vascular dementia begin with a noticeable expression of conservatism in the patient’s views, judgments and actions. At the same time, some character traits are aggravated. Excessive distrust or obstinacy, frugality and other changes appear.

Mental activity and memory gradually deteriorate. This is soon accompanied by unclear speech.

In addition, vascular dementia, which appears as a result of damage to certain areas of the brain, is manifested by a variety of symptoms:

1. Cell death in midbrain characterized by confusion and obscurity. With the further development of the disease, the patient withdraws into himself, loses interest in what is happening around him, in communicating with loved ones. He doesn't care about his appearance, and he stops following him.
2. Cell damage hippocampus(parts of the brain in the temple area), responsible for long-term storage of information, leads to amnesia. The patient cannot remember events that happened today or recently, although he can reproduce those that happened a long time ago.
3. V frontal lobes brain manifests itself in indifference, apathy, laziness, loss of interest in communication. There may be illogical behavior, which is expressed in the monotonous repetition of a phrase or word that has long been known to the patient.
4. At in the subcortical regions There is significant absent-mindedness of the patient's attention, which makes it impossible to concentrate on one task or subject. He cannot highlight the main thing and determine the secondary in the information received, or analyze it. All his endeavors are unsuccessful.

In addition to cognitive impairment, almost all patients have problems with urination, which often becomes spontaneous.
Emotional disorders and instability during the course of the disease often lead to depression, loss of optimism and self-confidence.

Methods for diagnosing pathology

Timely diagnosis of vascular dementia in the initial stages gives a chance for recovery; in more complex cases, a correct diagnosis and selected treatment will help stop the development of the disease. For this purpose, modern neurologists use the following research:

• studying the history of life and illness;
• conducting psychological tests to identify cognitive impairment;
• blood pressure control;
• clinical blood test;
• determination of blood sugar;
• determination of lipid content in the blood and the level of cholesterol concentration in it.

Modern instrumental diagnostic methods that determine the degree of damage to the blood vessels of the brain and its tissues:

• radioisotope research of the brain;
• (determination of blood flow);
• angiography (x-ray examination of blood vessels);
• echocardiography.

Studying the research results, their analysis and comparison allows us to establish an accurate diagnosis.

Principles of treatment of vascular dementia

Since there are many causative factors for the development of vascular dementia, its treatment is prescribed in accordance with their predominance and taking into account the mechanism of development of the disease. Therefore, treatment for each patient is selected individually and adjusted in the process.

Drug treatment is aimed primarily at reducing the risk of occurrence or recurrence of stroke and other cardiovascular diseases. vascular diseases.

This is provided by antiplatelet (antiplatelet) drugs that prevent the possibility of blood clots forming in blood vessels (Aspirin, Trental, Clopidogrel, Ticlopidine). The indirect anticoagulant Warfarin is also used.

Such drugs are prescribed and used with extreme caution, as they have a number of contraindications.

To improve cognitive functions and slow down the development of their disorders, Pentoxifylline and anticholisterase drugs are used - Donepezil (Aricept), Galantamine (Reminyl). At treatment of mild and moderate dementia, Memantine is used, which prevents the development of brain dysfunction.

Currently, drugs that lower blood cholesterol levels - statins (Simvastatin, Atorvastatin and others) are becoming popular in the treatment of dementia.

Do not lose their relevance (, Pramiracetam, Cerebrolysin), which have a complex effect on brain cells brain and improving its functions.

For patients with hypertension, blood pressure is monitored and medications are prescribed to reduce it. Thus, eliminating one of the serious factors in the development of the disease.

When mental problems appear, antidepressants are prescribed and relieved. Treatment at home is considered the most favorable, especially for mild and moderate stages of the disease.

Prognosis for recovery and life expectancy

Complete recovery was recorded in approximately 15% of patients in the initial stages of the disease. The rest most often die within 4-5 years of detection and treatment of senile dementia or earlier. The life expectancy of each patient with vascular dementia is different and it is difficult to predict.

In the case of a gradual and slow progression of the disease and maintaining the skills of daily life, you can live 10 - 20 years. In severe cases - no more than 10 years. But quality care and daily care from loved ones and relatives can prolong the patient’s life.

Concomitant diseases such as pneumonia and general purulent infection can also lead to death.

The general condition of the patient, the rate of progression of the pathology, living conditions and quality of care are decisive in their life expectancy.

Forewarned and forearmed!

A healthy and active lifestyle, complete abandonment of bad habits, moderate exercise, optimism, intellectual development, can protect older people from vascular dementia.

Treatment of diseases that are risk factors for vascular dementia and preventing their exacerbation is also an important preventive measure.

It is necessary to control blood pressure, blood sugar and cholesterol levels in order to prevent damage to the blood vessels of the brain and the development of senile dementia.

It is worth paying attention to nutrition. It should be varied and balanced, with a sufficient amount of vegetables and fruits, foods containing essential vitamins and microelements.

You should not abuse antidepressants and sleeping pills. Lots of communication, travel and new experiences will prevent the onset of dementia.

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Vascular dementia is an acquired mental disorder characterized by decreased intelligence, as well as impaired social adaptation of the patient. Vascular dementia makes the patient incapable of professional activity, significantly limits the ability to self-care, but is not accompanied by a disorder of consciousness.

The problem of acquired dementia is both medical and social, since it worsens the quality of life and causes economic losses. The main burden of caring for the sick falls on relatives, which further worsens the mental state of the caregiver. Intellectual defect in vascular dementia is marked by a complex disorder of some cognitive cognitive functions (memory, speech, attention, thinking), praxis is observed (the ability to make, plan a decision, and also control one’s actions).

In 20% of cases this disease resembles, and in 10% it has a combination of them. Unlike mental retardation (), which is characterized by disorders from birth, vascular dementia is marked by acquired organic lesions brain. Isolated impairments of certain cognitive functions (amnesia, aphasia, agnosia) are not considered acquired dementia, since intelligence remains unchanged.

Causes

The disease develops due to impaired cerebral circulation, as well as damage to brain tissue. Vascular dementia occurs due to most vascular diseases: atherosclerosis, arterial hypertension, cerebral vascular ischemia, hypotension, high lipid levels, arrhythmia, heart valve pathology, heart defects, increased level homocysteine.

The available results of post-mortem cases allow us to confidently assert that a heart attack is often the cause of vascular dementia, or more precisely a cyst that formed as a result of a myocardial infarction. The likelihood of vascular dementia directly depends on the volume of necrotic cerebral arteries.

Frequent provoking factors are intracerebral hemorrhages, intrathecal hemorrhages, repeated embolization due to cardiac pathology, autoimmune vasculitis, and nonspecific vasculopathies.

Risk factors include age over 60 years, smoking, peripheral vascular disease, male gender, heredity, sedentary lifestyle, and poor diet. The hypothesized factors include low educational level, as well as working profession. High level education is able to tap into the brain’s reserves, thereby delaying the onset of cognitive disorders.

Symptoms of vascular dementia

The symptom is a sharp decrease in cerebral circulation and metabolism.

If the disease is accompanied by laminar necrosis with the death of neurons, as well as the proliferation of glial tissue, then significant complications are possible (embolism - blockage of blood vessels, cardiac arrest).

Risks for acquired dementia include cardiac pathologies, hyperlipidemia, and diabetes mellitus.

Symptoms are often diagnosed in people 58-75 years old. The disease is 1.5 times more common in men and accounts for 20% of all diagnosed cases of dementia.

Modern basic research suggest that cerebral vascular insufficiency is an important factor in the pathogenesis of Alzheimer's disease. The risk of Alzheimer's disease, as well as the rate of progression of cognitive changes associated with vascular dementia, is higher in patients with cardiovascular disease. vascular pathology(atherosclerosis, hypertonic disease).

The initial stage of the disease is marked by irritability, lethargy, fatigue, weakness, sleep disturbances, and headaches. Absent-mindedness, as well as other defects, become systematic. Emotional incontinence is noted in the form of weakness, hot temper, and depressive feelings. Subsequently, memory impairments are observed, which are expressed in disorientation, in a decrease in the importance of other people (peculiarities of personal sympathies, forgetting names).

Life expectancy is significantly reduced among patients who have had strokes. Focal neurological symptoms are: rigidity, hemiparesis, speech disorders, hypokinesis, swallowing disorders; as well as neuropsychological spot-like disorders (apraxia, dominant aphasia, lack of sensory sensitivity), urination disorders and gait disorders (spastic, Parkinson-like and apraxic movements).

One form of vascular dementia is Binswanger's disease (arteriosclerotic subcortical encephalopathy). The disease was first described by Binswanger in 1894. It is characterized by progressive dementia, as well as episodes with acute development of focal symptoms and progressive neurological disorders.

Binswanger's disease is directly associated with damage to the white matter in the cerebral hemispheres. Previously, this disease was classified as rare and was diagnosed only posthumously. However, the introduction of neuroimaging methods into practice has shown that Binswanger's disease is observed quite often.

Binswanger's disease accounts for up to a third of the total number of cases of acquired dementia. Many neurologists suggest that this disease is a variant of the development of hypertensive angioencephalopathy. With this disease, small focal changes are noted.

Diagnosis of vascular dementia is carried out by somatic examination and targeted laboratory research which detect infarcts as well as white matter lesions. Computer X-ray and magnetic resonance imaging are indispensable in these examinations.

Treatment of vascular dementia

During treatment, a problem arises related to the ambiguity of judgments about the occurrence of the causes of the disease. After the concept of multi-infarct dementia has been developed, therapy is used that reduces the risk of developing cerebral infarctions, while taking into account their causes. Currently, a differentiated approach is being taken to vascular dementia, since this disease includes several defined syndromes. The main principles of therapy are the prevention of progression of vascular dementia, as well as improvement of cognitive functions and general therapeutic measures.

There is no single approach to treatment. The leading direction of therapy for damage to small vessels is the normalization of blood pressure. An excessive decrease in pressure can lead to mnestic-intellectual disorders.

Prevention of cerebral infarctions is carried out with antiplatelet agents. If there are corresponding cardiac changes, then antiplatelet agents and anticoagulants are used to prevent embolism. To improve cognitive functions, peptidergic drugs (Cerebrolysin), calcium channel antagonists, and nootropics are used. For a number of disorders (insomnia, episodes of agitation, nighttime confusion, etc.), the response to treatment is assessed for each individual patient. After a while, it is necessary to reconsider treatment to avoid long-term use of medications.

The progression of the disease, as well as recurrent strokes, can lead to complete dependence of patients on the help of other people. Patients become immobilized and require catheterization Bladder, as well as tube feeding. In this case, urinary infection should be prevented, respiratory infections, aspiration. Specific rehabilitation measures are also important: adequate hygienic measures, prevention of contractures, as well as trophic ulcers. Treatment of arterial hypertension, as well as somatic diseases carried out by appropriate specialists.

As a common form of dementia, the course of the disease tends to progress. However, it is impossible to cure the disease, but you can only slow down the process, prolong the patient’s life, and also relieve unpleasant symptoms.

With rapid progression of the disease, the prognosis is unfavorable. The patient's death occurs several years (sometimes months) after the first signs of the disease appear. The cause of death may be concomitant diseases (sepsis, pneumonia).

Doctor of the Medical and Psychological Center "PsychoMed"

The information provided in this article is for informational purposes only and is not intended to substitute for professional advice and qualified advice. medical care. If you have the slightest suspicion that you have vascular dementia, be sure to consult your doctor!

Vascular dementia is an acquired impairment of a person’s memory and intellectual abilities due to cerebral vascular diseases. With a lack of oxygen, brain cells responsible for behavior and perception die, changing the patient beyond recognition. Most often, signs of dementia appear in old age, and you need to clearly understand that it is not directly a disease.

Types and causes of vascular dementia

The International Classification of Diseases (10th revision) assigned DM code F01 and identified the following types:

• With acute onset (F01.0). Behavioral disorders occur quickly, within 1-3 months after the first or subsequent strokes. May be due to hemorrhage, cerebrovascular thrombosis or embolism.
• Multi-infarction (F01.1). Mostly cortical. Signs appear over 3-6 months, gradually, usually followed by ischemic episodes. In this case, heart attacks seem to accumulate in certain parts of the brain.
• Subcortical (F01.2). Doctors call it subcortical. With this type of disorder, most of the damage affects the deep parts of the white matter.
• Mixed cortical and subcortical (F01.3).
• Unspecified (F01.9).
• Other (F01.8). This may include dementia after a stroke.

However, it is impossible to talk about a clear division into cortical (cortical) and subcortical, because in the later stages of diabetes it affects all areas of the brain.

Brain diseases are considered the most dangerous diseases, since most often their consequences are irreversible. So it is extremely heavy, which usually has quite large dimensions.

Its consequences can be post-traumatic encephalopathy and disability.

Stages of vascular dementia

Dementia is preceded by 3 stages:

• The emergence of risk factors for development. For example, a predisposition to vascular diseases.
• Ischemic damage in the initial stage. At this stage, brain lesions can be diagnosed, however, they do not appear externally. In this case, leukoaraiosis and “silent” heart attacks are observed.
• Beginning of the symptomatic stage. It is difficult to make a diagnosis at this stage, since the lesions are small and do not significantly affect the behavior and perception of the patient. Disorders can only be detected through neuropsychological testing.

The history of the development of vascular dementia includes several stages and proceeds as follows:

• initial stage or the appearance of moderate cognitive impairment of vascular origin.
• Clinical diagnosis of diabetes. At this stage, the signs of dementia are already clearly expressed, the patient behaves either aggressively or apathetically, and memory lapses appear.
• Severe or severe diabetes. The patient needs constant monitoring and is completely dependent on others.
• Death. In general, death does not occur due to dementia (with rare exceptions such as accidents), but as a consequence of a heart attack or stroke.

Symptoms of vascular dementia

Since dementia is not a single disease, but a syndrome that affects a person's behavior in different ways, it is difficult to indicate the exact changes that accompany it.

But we can talk about the symptoms that occur in most cases, as well as the most basic signs.

According to statistics, the most common symptoms of vascular dementia are:

• Epileptic seizures (20-34% depending on the disease).
• Walking disorders (30-95%). This includes unsteadiness, slight limp, shuffling steps and similar signs.
• Urinary disorders (almost 90%).
• Deterioration of cognitive functions, for example, memory, orientation, attention (100%).
• Decrease in physical functions, without deterioration in motor skills (100%).

Other signs depend on the general picture of the disease, the type and stage of development of dementia.

initial stage

Symptoms at the initial stage are characteristic of many diseases and are therefore difficult to distinguish.

These include:

• The appearance of neurosis-like disorders (lethargy, apathy, irritability);
• Absent-mindedness and inattention.
• The appearance of nightmares and other sleep disorders.
• Depression.
• Disturbances in orientation outside the home.
• Emotional instability, sudden mood swings.

Middle stage

At this stage, symptoms become noticeable and easily diagnosed:

• Mood swings become more severe. Aggression appears, giving way to deep apathy.
• Short-term memory lapses.
• Disorientation within the home.
• Difficulties in communication associated with forgetfulness of even frequently used words and reluctance to make contact.
• Violations of physical functions, for example, the vestibular apparatus, and, as a consequence, the need for self-care.

Heavy stage

At the last stage, all previous symptoms become extreme:

• Lost in space and time.
• Delusions and hallucinations.
• Memory losses. This also applies to close relatives, events that happened a few minutes ago.
• Unreasonable aggression.
• Difficulty moving, including the inability to get out of bed.
• The need for constant self-care.

Signs of diabetes

In addition to the main symptoms, there are signs by which the disease can be more accurately determined.

For vascular dementia this is:

• Short-term recovery of cognitive functions. The reasons for this effect are not fully understood. Most often occurs during intellectual stress. The patient's condition may improve almost to normal level, but vascular dementia itself will not go away.
• Smooth development. It is the smooth and slow development of diabetes that prevents its diagnosis, especially in the elderly. Relatives of patients often admit that they noticed minor changes, but paid attention to them when it was too late.

  After a single stroke, the behavior of a patient with dementia may not change at all until the middle stage. Acute development of diabetes occurs only in 20-38% of cases.

• Abdominal or trauma surgeries, as well as coronary artery bypass surgery, precede symptoms.

  In patients, especially the elderly, new vascular lesions appear:
  — After cerebral angiography in 15-26% of cases.
  — After operations on the carotid arteries in 17-54%.
  — After heart surgery and other cardiac surgeries 31-48%.

Diagnosis of vascular dementia

Diagnostics of diabetes is carried out by a doctor based on the above signs and symptoms.

The following can be used to make a diagnosis:

• NINDS-AIREN Working Group Criteria
• International classification of diseases in the 10th revision.
• ADDTC criteria.
• DSM-IV criteria.
• Khachinsky ischemic scale.

It all depends on the training of the specialist and the theories he follows. In fact, they differ only slightly, and at the medium and severe stages they practically repeat each other.

If the patient has significant neurological symptoms or cerebrovascular disease, a thorough evaluation for stroke is necessary.

During diagnosis, a CT scan may be prescribed to reveal:

• multiple heart attacks;
• lacunar cysts;
• white matter damage.

Treatment of vascular dementia

Vascular dementia most often cannot be cured, since the changes in the brain are irreversible. But it is possible to overcome changes that are not functional in nature (do not affect physical and mental abilities).

The need for treatment is clearly indicated by a graph showing the effect of therapy:

It should be noted here that the type of therapy can only be prescribed by a doctor. Measures taken independently can worsen the patient’s condition and literally lead him to the grave. If you prefer any specific treatment method, discuss the issue with your specialist before using it.

Treatment methods

It is a mistake to treat dementia as a disease, since dementia is a syndrome that includes several diverse symptoms. The easiest way to treat dementia is while still healthy, trying to prevent dementia.

But despite this, there are several treatment methods that are used in combination:

• Medication;
• Preventative;
• Folk remedies.

Drug treatment

The effectiveness of this method has not been fully proven. However, careful studies have been carried out on some drugs and it has been possible to confirm the improvement in the condition of patients with dementia.

Mostly, drug treatment helps reduce risk factors for stroke.

For this purpose it is used in small doses:

• Warfarin;
• aspirin;
• ticlopidine;
• cloppdogrel.

The remaining medications are aimed at partially eliminating the patient’s symptoms.

So, to improve cognitive (intellectual) abilities, a doctor may prescribe:

• Pentoxfylline;
• memantine;
• cholinesterase inhibitors;
• pentoxpphylline.

In cases of depression and post-stroke anxiety, antidepressants may be prescribed. And when acute psychosis appears, antipsychotics are prescribed.

If the patient has been diagnosed with post-stroke mania (and it is confirmed that its cause is dementia), then serious medications will be required, for example:

• Lithium;
• carbamazepine;
• valproic acid;
• gabapeptin.

Prevention and prognosis for vascular dementia

Prevention of vascular dementia involves preventing cardiovascular diseases. But it often happens that a person finds out about this possibility too late, when dementia has reached the middle stage.

In any case, this is not a reason to abandon preventive measures, since in most cases, patients get better if they follow these recommendations:

• Quitting alcohol and smoking.
• Refusal of fatty foods.
• Daily physical exercise. There is no need to make a bodybuilder out of your grandmother, but even she can devote 2 times 5-10 minutes to a light warm-up.
• Daily intellectual loads. This includes crossword puzzles, reading, memory exercises and the like.
• Control blood pressure and cholesterol levels.

Folk remedies

Efficiency folk remedies also not proven, however, in rare cases, patients may feel better when using some of them, for example:

• Turmeric. Can be added to dishes as a seasoning.
• Elecampane.
• A decoction of Irish moss and flaxseed. Take 1 tbsp. spoon of each and boil in 0.5 liters of water for 20 minutes.
• A preparation from the Ginkgo biloba plant.

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Life expectancy with vascular dementia

Since the development of vascular dementia is more complex than in other types, life expectancy depends on the measures taken and the stage at which dementia was detected. But unfortunately, it does not exceed 5-6 years with rare exceptions.

Preventing vascular dementia is easier than treating it, because there is no universal cure for dementia. And although life expectancy with diabetes is short, you have the power to improve the patient’s quality of life, not only with the help of medications and timely diagnosis.

It is very important for people with dementia to communicate with loved ones.

Vascular dementia. How to preserve your memory and mind, TV show “Live Healthy”:

Dementia or dementia is one of the types of cognitive mental disorders associated with the cognitive sphere of a person. Depending on the severity of dementia symptoms, the disease can be mild, moderate or severe.

With a mild degree of dementia, only the patient’s professional qualities deteriorate and his social activity decreases. A symptom of moderate dementia is loss of ability to use most household objects. At the stage of severe dementia, a person is completely maladapted and dependent on others. He is not able to independently cope with the simplest problems of hygiene or food intake.

Depending on the cause of dementia, there are two main types of disease: senile dementia (also known as senile dementia) or vascular dementia.

Senile dementia

Senile or senile dementia is caused by age-related changes in the structure of the brain. Changes gradually occur at the neural level and are provoked by both insufficient blood supply to the brain and other chronic diseases or acute infections. The cause of senile dementia can be metabolic problems, pathologies of the kidneys and adrenal glands, immunodeficiency, malignant neoplasms or neurodegenerative disorders, such as Alzheimer's disease.

Senile dementia is an irreversible disorder that affects all cognitive spheres of the psyche: thinking, memory, speech, attention. The progression of the disease is accompanied by the loss of all acquired skills and abilities. The ability to acquire new knowledge in patients with senile dementia is also sharply limited.

One of the main symptoms of this type of dementia is the stability of the manifestation of signs of dementia, in contrast to delirium, when the patient experiences temporary attacks of disorientation.

The expression “senile dementia” is often used as a common definition for senile dementia. The disease affects older people over 65 years of age. On average, 5-15% of the world's retirement age population suffers from various manifestations of dementia symptoms.

Vascular dementia develops as a result of cerebrovascular accidents caused by damage to brain tissue. Most vascular diseases can lead to vascular dementia, for example, arterial hypertension, atherosclerosis, cerebral vascular ischemia, etc.

The results of post-mortem studies of the brain structures of patients with vascular dementia suggest that the cause of the disease is often a heart attack. Or rather, not the myocardial infarction itself, but the cyst formed as a result of it. Moreover, the likelihood of developing vascular dementia does not depend on the size of the damaged cerebral artery, but on the total volume of necrotic cerebral arteries.

A symptom of vascular type dementia is a sharp decrease in cerebral circulation and metabolism. If the disease is accompanied by laminar necrosis with the death of neurons and proliferation of glial tissue, serious complications are possible in the form of embolism (blockage of blood vessels) and cardiac arrest.

Risk factors for vascular dementia are various cardiac pathologies, diabetes mellitus, and hyperlipidemia (increased levels of lipids in the blood).

Symptoms of vascular dementia are most often diagnosed between the ages of 60 and 75 years. The disease is 1.5 times more common in men and accounts for 50% of all cases of diagnosed dementia.

Common symptoms of different types of dementia

The average duration of the disease is 5 years with gradual increasing changes in the patient’s personality. First obvious symptoms dementia – sharpening of certain character traits of a person, for example, frugality, stubbornness, suspiciousness, etc. A sick person with progressive vascular or senile dementia exhibits conservatism in actions, judgments and has difficulty accepting anything new. His interests are narrowed, his ability to think is deteriorated, and moral standards of behavior are lost.

As the disease progresses, a person may have difficulty recalling recently occurring events. Then orientation in time and space is lost, although behavior, speech, facial expressions and gestures remain unchanged for a long time.

Physical symptoms of dementia: exhaustion, tremor of the hands, changes in gait - develop only at the most severe stage of the disease, along with increasing signs of personality disintegration.

Diagnosis of dementia

A diagnostic sign of dementia is atrophic processes in the brain. Their recognition is carried out using computed tomography brain. With a pronounced decrease in the patient’s cognitive abilities and detected vascular lesions of the brain, making a diagnosis is not difficult.

Much is written in medical journals about additional diagnostic method differentiation of vascular dementia from Alzheimer's disease - the so-called Khachinsky scale. It is a list of 13 symptoms of dementia. A match on 7 points or more indicates the likelihood of vascular dementia; a statement of less than 7 symptoms is characteristic of Alzheimer's disease.

Dementia treatment

There is currently no effective treatment for dementia, especially when it comes to severe senile dementia. However, when proper care for the sick and symptomatic treatment dementia, serious relief of the patient's lot is possible.

The recommended setting for treating dementia is the home environment. Hospitalization and placement of the patient in a psychiatric department is recommended only for severe senile dementia. The desired daily routine, which the patient’s relatives should provide, is maximum activity and simple household chores.

Psychotropic drugs in the treatment of dementia are prescribed only for insomnia or hallucinations. In the early stages of treating dementia, it is advisable to prescribe nootropics, and later tranquilizers and nootropics.

There is no effective prevention of vascular or senile dementia, as well as treatment.

Video from YouTube on the topic of the article: